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Lumbar Spinal Stenosis: Should I Have Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Lumbar Spinal Stenosis: Should I Have Surgery?

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Get the facts

Your options

Don't have surgery. Try things like changing the way you do your activities, taking medicines to manage pain, doing exercise, or getting physical therapy instead.

Key points to remember

Spinal stenosis in the low back (lumbar spine) can cause pain, numbness, or weakness in the back, buttocks, and legs. Symptoms may be very bad at times and not so bad at
other times.

Many people are able to manage their symptoms with things like changing the way they do their activities, taking medicines to manage pain, doing exercise, or getting physical therapy. If one of these things doesn't work, you can try something else or combine some of them.

You may want
to have surgery if you have tried other treatments for a few months and your pain or other symptoms are still so
bad that you can't do your normal activities.

Back surgery has some risks, including infection, nerve damage, and the chance that the surgery won't relieve your symptoms. And even if you get better with surgery, there is a chance that you may get new symptoms in the future.

Surgery may work better than nonsurgical treatments to relieve pain and help you move around easier. Surgery may relieve pain in the buttock and leg more than it relieves pain in the back.

Lumbar spinal stenosis is the
narrowing of the spinal canal in the low back. It usually occurs when bone and other tissues grow
inside the openings in the spinal bones. This can squeeze the nerves that
branch out from the spinal cord. The
squeezing can cause pain, numbness, or weakness, most often in the back, buttocks, legs, or feet.

Symptoms may be very bad at times and not so bad at
other times.

Arthritis is the most common cause of spinal stenosis. There are a lot things that can help relieve your symptoms, but they won't make your arthritis go away. Over time, your arthritis may get worse, and symptoms of spinal stenosis may come back.

There are several treatments that don't involve surgery that can help you feel better, be more active, and avoid surgery. These include:

Changing the way you do your activities. This means trying other ways of doing your activities that don't cause pain or make other symptoms worse. For example, this might mean using a tall stool for tasks that you would normally do standing up. Or you could use a shopping cart or a wheeled walker so that you're leaning forward a little when you walk.

Taking medicines to manage pain.
These include acetaminophen (such as Tylenol) and nonsteroidal anti-inflammatory drugs like ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve). Be safe with medicines. Read and follow all instructions on the label.

Doing exercise. Aerobic exercise can help your symptoms. You can try walking on a treadmill with a slight incline. Or you could ride a stationary bike. In both of these types of exercise, your spine tilts forward a little as you work out. So they might be more comfortable for you than other exercise.

Getting physical therapy. This helps
you learn stretching and strength exercises that may reduce pain and other
symptoms. The goal of physical therapy is to make your daily tasks and activities easier.

Getting steroid injections. These are
shots that are sometimes tried to help leg pain by reducing inflammation in the nerve root if other nonsurgical treatments haven't worked. These shots may work for some people. But they help relieve symptoms for only a short time.

Decompressive laminectomy is the most common type of surgery to treat lumbar spinal stenosis. This surgery is done to relieve pressure on the spinal nerve roots. It removes
bone (parts of the vertebrae), thickened tissue, or both to keep them from narrowing the
spinal canal and squeezing or irritating the spinal nerves.

In some
cases,
spinal fusion may be done at the same time to help keep the spine stable. This
surgery joins, or fuses, two or more bones so that the joints can no longer
move. This surgery is more complicated and has more risks. And it's usually not needed unless you have other back problems along with spinal stenosis.

Some surgeons are doing newer, less invasive procedures. They are inserting small metal devices—called interspinous process devices—between the bones of the spine, near where the nerve roots leave the spinal cord. The idea is to create more space between the bones to take pressure off the nerve roots. This may be an option for some people. But not all surgeons do the procedure. And studies haven't yet shown how well the devices work over the long term.

Surgery may work better than nonsurgical treatments to relieve pain and help you move better. If nonsurgical treatments have not worked well enough, surgery might be able to help you.footnote 1

By 3 months, people who had surgery notice more improvement in their symptoms and can be more active than people who did not have surgery.footnote 1 This difference continues for at least 4 years after surgery.footnote 2

The benefits of surgery appear to last for many years. After 8 to 10
yearsfootnote 3:

People treated with surgery were as
satisfied as those treated without surgery.

People who had surgery
were generally able to be more active and had less leg pain than those who had
nonsurgical treatment.

Surgery appears to work better for leg pain than for back pain, but it may help your back pain too.footnote 4

For most people, it's safe to try nonsurgical treatments for several months before thinking about surgery. Many people are able to manage their symptoms with things like changing the way they do their activities, taking medicines to manage pain, doing exercise, or getting physical therapy.

But if these other treatments don't work, not having surgery means that you may still have pain or other symptoms that make it hard for you to do your daily activities.

There is little or no risk in not having surgery unless you have serious symptoms. These symptoms include having trouble controlling your bladder or bowels, numbness or weakness, and sudden changes in the way you walk or move. These symptoms aren't likely to get better on their own, and they could get worse.

Your pain and weakness are bad enough to get
in the way of your normal activities and have become more than you can
manage.

You've tried other treatments—changing the way you do your activities, taking medicines to manage pain, doing exercise, or getting physical
therapy—for at least a few months, and they haven't worked.

You are
less able to control your bladder or bowels than usual.

You notice
sudden changes in your ability to walk in a steady way, or your movement
becomes clumsy.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Have surgery Have surgery

You are asleep during surgery.

You stay in the hospital for a few days.

It can take
up to several months before you go back to your normal activities.

Most people who have surgery are
satisfied with the results.

Surgery may work better than nonsurgical treatments to relieve pain and help you move around easier. Surgery may relieve pain in the buttock and leg more than it relieves pain in the back.

All surgery has some
risks, such as bleeding, infection, and risks from
anesthesia.

Risks from surgery for spinal stenosis include damage to the nerves, tissue tears, chronic pain, and trouble passing urine.

You may not be able to go back to all of your normal
activities for at least several months.

There is a chance that surgery might not relieve your symptoms. And even if you get better with surgery, there is a chance that you may get new symptoms in the future.

Don't have surgery
Don't have surgery

You try to manage your symptoms with things like changing the way you do your activities, taking medicines to manage pain, doing exercise, or getting physical therapy.

Many people are able to manage their symptoms with things like changing the way they do their activities, taking medicines to manage pain, doing exercise, or getting physical therapy.

You
avoid the cost and risks of surgery.

If other treatments don't work, you may still have pain or other symptoms that make it hard for you to do your daily activities.

Some medicines you take for pain may have side effects.

You may still need surgery later.

Personal stories about having surgery for spinal stenosis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

The pain and
numbness in my legs got to the point where I could hardly walk. After my MRI
showed I had spinal stenosis, my doctor said that the final decision for
treatment was up to me. I should consider how bad the pain is and whether I can
do my normal daily activities. Since I could hardly do my simple everyday
routines without pain, I figured that it was time for surgery.

Ed, age
62

I have been working with a physical therapist for several months now to relieve my leg pain that is caused by
spinal stenosis. My doctor says surgery may be an option if my leg pain gets
worse. But I want to wait and see if other steps help relieve the pain first.
The physical therapy seems to be working, so I will stick with it for now.

Tom, age
52

I noticed the numbness and pain in my legs
for a while. It came on gradually, and I could manage it with pain relievers.
Over time, though, the symptoms got worse and worse, even though I tried physical therapy and changing the way I do certain activities. Eventually, the pain got
so bad that walking was quite uncomfortable. Since I don't have any other major
health problems, I decided to have surgery so I wouldn't have to deal with the
leg pain and could start walking again!

Clare, age 70

The pain,
numbness, and tingling in my legs started about 5 years ago. Luckily, I did not
feel pain all of the time when I was walking. When I was diagnosed with spinal
stenosis, my doctor said that there were several things I could do to keep my
pain at a minimum, such as using pain relievers and exercising. That's what I'm doing, and now I hardly ever get leg pain. I'm relieved that I avoided surgery.

Susan, age 64

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for lumbar spinal stenosis

Reasons not to have surgery

I want surgery if there is a chance it will help me.

I want to avoid surgery at all costs.

More important

Equally important

More important

My work and home life are flexible enough that I can take the time I need to recover after surgery.

I can't afford to take time off.

More important

Equally important

More important

Nonsurgical treatments have not worked well enough for me.

I want to keep trying nonsurgical treatments and see if they help me feel better and move around easier.

More important

Equally important

More important

Getting relief from my pain and weakness will be worth it, even if I need to have the surgery again in a few years.

I'm not sure it's worth it to have surgery that might need to be repeated in a few years.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.1, Is surgery the only thing you can try to make your symptoms better?

YesNo, that's not right. Many people are able to manage their symptoms with things like changing the way they do their activities, taking medicines to manage pain, doing exercise, or getting physical therapy.

NoThat's correct. Many people are able to manage their symptoms with things like changing the way they do their activities, taking medicines to manage pain, doing exercise, or getting physical therapy.

I'm not sureIt may help to go back and read "Get the Facts." Many people are able to manage their symptoms with things like changing the way they do their activities, taking medicines to manage pain, doing exercise, or getting physical therapy.

2.2, Will surgery help your leg pain?

YesThat's right. Surgery may work better than nonsurgical treatments to relieve pain and help you move around easier. Surgery may relieve pain in the buttock and leg more than it relieves pain in the back.

NoSorry, that's wrong. Surgery may work better than nonsurgical treatments to relieve pain and help you move around easier. Surgery may relieve pain in the buttock and leg more than it relieves pain in the back.

I'm not sureIt may help to go back and read "Get the Facts." Surgery may work better than nonsurgical treatments to relieve pain and help you move around easier. Surgery may relieve pain in the buttock and leg more than it relieves pain in the back.

3.3, If you have surgery, will the results last for a long time?

YesThat's correct. When surgery helps relieve symptoms, the results appear to last for several years.

NoNo, that's not right. When surgery helps relieve symptoms, the results appear to last for several years.

I'm not sureIt may help to go back and read "Get the Facts." When surgery helps relieve symptoms, the results appear to last for several years.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Lumbar Spinal Stenosis: Should I Have Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Have surgery to relieve your symptoms.

Don't have surgery. Try things like changing the way you do your activities, taking medicines to manage pain, doing exercise, or getting physical therapy instead.

Key points to remember

Spinal stenosis in the low back (lumbar spine) can cause pain, numbness, or weakness in the back, buttocks, and legs. Symptoms may be very bad at times and not so bad at
other times.

Many people are able to manage their symptoms with things like changing the way they do their activities, taking medicines to manage pain, doing exercise, or getting physical therapy. If one of these things doesn't work, you can try something else or combine some of them.

You may want
to have surgery if you have tried other treatments for a few months and your pain or other symptoms are still so
bad that you can't do your normal activities.

Back surgery has some risks, including infection, nerve damage, and the chance that the surgery won't relieve your symptoms. And even if you get better with surgery, there is a chance that you may get new symptoms in the future.

Surgery may work better than nonsurgical treatments to relieve pain and help you move around easier. Surgery may relieve pain in the buttock and leg more than it relieves pain in the back.

FAQs

What is lumbar spinal stenosis?

Lumbar spinal stenosis is the
narrowing of the spinal canal in the low back. It usually occurs when bone and other tissues grow
inside the openings in the spinal bones. This can squeeze the nerves that
branch out from the spinal cord. The
squeezing can cause pain, numbness, or weakness, most often in the back, buttocks, legs, or feet.

Symptoms may be very bad at times and not so bad at
other times.

Arthritis is the most common cause of spinal stenosis. There are a lot things that can help relieve your symptoms, but they won't make your arthritis go away. Over time, your arthritis may get worse, and symptoms of spinal stenosis may come back.

What nonsurgical treatments are used for spinal stenosis?

There are several treatments that don't involve surgery that can help you feel better, be more active, and avoid surgery. These include:

Changing the way you do your activities. This means trying other ways of doing your activities that don't cause pain or make other symptoms worse. For example, this might mean using a tall stool for tasks that you would normally do standing up. Or you could use a shopping cart or a wheeled walker so that you're leaning forward a little when you walk.

Taking medicines to manage pain.
These include acetaminophen (such as Tylenol) and nonsteroidal anti-inflammatory drugs like ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve). Be safe with medicines. Read and follow all instructions on the label.

Doing exercise. Aerobic exercise can help your symptoms. You can try walking on a treadmill with a slight incline. Or you could ride a stationary bike. In both of these types of exercise, your spine tilts forward a little as you work out. So they might be more comfortable for you than other exercise.

Getting physical therapy. This helps
you learn stretching and strength exercises that may reduce pain and other
symptoms. The goal of physical therapy is to make your daily tasks and activities easier.

Getting steroid injections. These are
shots that are sometimes tried to help leg pain by reducing inflammation in the nerve root if other nonsurgical treatments haven't worked. These shots may work for some people. But they help relieve symptoms for only a short time.

What is the surgery for lumbar spinal stenosis?

Decompressive laminectomy is the most common type of surgery to treat lumbar spinal stenosis. This surgery is done to relieve pressure on the spinal nerve roots. It removes
bone (parts of the vertebrae), thickened tissue, or both to keep them from narrowing the
spinal canal and squeezing or irritating the spinal nerves.

In some
cases,
spinal fusion may be done at the same time to help keep the spine stable. This
surgery joins, or fuses, two or more bones so that the joints can no longer
move. This surgery is more complicated and has more risks. And it's usually not needed unless you have other back problems along with spinal stenosis.

Some surgeons are doing newer, less invasive procedures. They are inserting small metal devices—called interspinous process devices—between the bones of the spine, near where the nerve roots leave the spinal cord. The idea is to create more space between the bones to take pressure off the nerve roots. This may be an option for some people. But not all surgeons do the procedure. And studies haven't yet shown how well the devices work over the long term.

How well does surgery work?

Research shows
that:

Surgery may work better than nonsurgical treatments to relieve pain and help you move better. If nonsurgical treatments have not worked well enough, surgery might be able to help you.1

By 3 months, people who had surgery notice more improvement in their symptoms and can be more active than people who did not have surgery.1 This difference continues for at least 4 years after surgery.2

The benefits of surgery appear to last for many years. After 8 to 10
years3:

People treated with surgery were as
satisfied as those treated without surgery.

People who had surgery
were generally able to be more active and had less leg pain than those who had
nonsurgical treatment.

Surgery appears to work better for leg pain than for back pain, but it may help your back pain too.4

What are the risks of surgery for lumbar spinal stenosis?

Surgery may not be an option if you have other serious health problems
that make surgery too risky.

All surgery has risks. These risks
may be more serious for an older adult. Possible problems from surgery include:

Tears in the fibrous tissue that
covers the spinal cord and the nerve near the spinal cord. These tears may require
more surgery.

Trouble passing urine, or loss of bladder or bowel
control.

Long-term (chronic) pain, which happens after surgery in
some cases.

The chance that the surgery won't relieve your symptoms. And even if you get better with surgery, there is a chance that you may get new symptoms in the future.

Death from problems caused by surgery, but this is rare.

Symptoms may return after several years. A second surgery may be needed if:

Spinal stenosis develops in another area of the spine.

An earlier surgery didn't control symptoms.

Tissue regrows and presses on the spinal cord or spinal nerve roots.

What are the risks of not having surgery
for lumbar spinal stenosis?

For most people, it's safe to try nonsurgical treatments for several months before thinking about surgery. Many people are able to manage their symptoms with things like changing the way they do their activities, taking medicines to manage pain, doing exercise, or getting physical therapy.

But if these other treatments don't work, not having surgery means that you may still have pain or other symptoms that make it hard for you to do your daily activities.

There is little or no risk in not having surgery unless you have serious symptoms. These symptoms include having trouble controlling your bladder or bowels, numbness or weakness, and sudden changes in the way you walk or move. These symptoms aren't likely to get better on their own, and they could get worse.

Why might your doctor recommend surgery for lumbar spinal stenosis?

Your doctor might recommend surgery if:

Your pain and weakness are bad enough to get
in the way of your normal activities and have become more than you can
manage.

You've tried other treatments—changing the way you do your activities, taking medicines to manage pain, doing exercise, or getting physical
therapy—for at least a few months, and they haven't worked.

You are
less able to control your bladder or bowels than usual.

You notice
sudden changes in your ability to walk in a steady way, or your movement
becomes clumsy.

2. Compare your options

Have surgery

Don't have surgery

What is usually involved?

You are asleep during surgery.

You stay in the hospital for a few days.

It can take
up to several months before you go back to your normal activities.

You try to manage your symptoms with things like changing the way you do your activities, taking medicines to manage pain, doing exercise, or getting physical therapy.

What are the benefits?

Most people who have surgery are
satisfied with the results.

Surgery may work better than nonsurgical treatments to relieve pain and help you move around easier. Surgery may relieve pain in the buttock and leg more than it relieves pain in the back.

Many people are able to manage their symptoms with things like changing the way they do their activities, taking medicines to manage pain, doing exercise, or getting physical therapy.

You
avoid the cost and risks of surgery.

What are the risks and side effects?

All surgery has some
risks, such as bleeding, infection, and risks from
anesthesia.

Risks from surgery for spinal stenosis include damage to the nerves, tissue tears, chronic pain, and trouble passing urine.

You may not be able to go back to all of your normal
activities for at least several months.

There is a chance that surgery might not relieve your symptoms. And even if you get better with surgery, there is a chance that you may get new symptoms in the future.

If other treatments don't work, you may still have pain or other symptoms that make it hard for you to do your daily activities.

Some medicines you take for pain may have side effects.

You may still need surgery later.

Personal stories

Personal stories about having surgery for spinal stenosis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"The pain and numbness in my legs got to the point where I could hardly walk. After my MRI showed I had spinal stenosis, my doctor said that the final decision for treatment was up to me. I should consider how bad the pain is and whether I can do my normal daily activities. Since I could hardly do my simple everyday routines without pain, I figured that it was time for surgery."

— Ed, age
62

"I have been working with a physical therapist for several months now to relieve my leg pain that is caused by spinal stenosis. My doctor says surgery may be an option if my leg pain gets worse. But I want to wait and see if other steps help relieve the pain first. The physical therapy seems to be working, so I will stick with it for now."

— Tom, age
52

"I noticed the numbness and pain in my legs for a while. It came on gradually, and I could manage it with pain relievers. Over time, though, the symptoms got worse and worse, even though I tried physical therapy and changing the way I do certain activities. Eventually, the pain got so bad that walking was quite uncomfortable. Since I don't have any other major health problems, I decided to have surgery so I wouldn't have to deal with the leg pain and could start walking again!"

— Clare, age 70

"The pain, numbness, and tingling in my legs started about 5 years ago. Luckily, I did not feel pain all of the time when I was walking. When I was diagnosed with spinal stenosis, my doctor said that there were several things I could do to keep my pain at a minimum, such as using pain relievers and exercising. That's what I'm doing, and now I hardly ever get leg pain. I'm relieved that I avoided surgery."

— Susan, age 64

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for lumbar spinal stenosis

Reasons not to have surgery

I want surgery if there is a chance it will help me.

I want to avoid surgery at all costs.

More important

Equally important

More important

My work and home life are flexible enough that I can take the time I need to recover after surgery.

I can't afford to take time off.

More important

Equally important

More important

Nonsurgical treatments have not worked well enough for me.

I want to keep trying nonsurgical treatments and see if they help me feel better and move around easier.

More important

Equally important

More important

Getting relief from my pain and weakness will be worth it, even if I need to have the surgery again in a few years.

I'm not sure it's worth it to have surgery that might need to be repeated in a few years.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Is surgery the only thing you can try to make your symptoms better?

Yes

No

I'm not sure

That's correct. Many people are able to manage their symptoms with things like changing the way they do their activities, taking medicines to manage pain, doing exercise, or getting physical therapy.

2.
Will surgery help your leg pain?

Yes

No

I'm not sure

That's right. Surgery may work better than nonsurgical treatments to relieve pain and help you move around easier. Surgery may relieve pain in the buttock and leg more than it relieves pain in the back.

3.
If you have surgery, will the results last for a long time?

Yes

No

I'm not sure

That's correct. When surgery helps relieve symptoms, the results appear to last for several years.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

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